Provider Demographics
NPI:1780721852
Name:PARK, JAMES KEONUK (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEONUK
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SUNNYCREST DR
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3638
Mailing Address - Country:US
Mailing Address - Phone:714-870-6120
Mailing Address - Fax:714-870-6869
Practice Address - Street 1:1950 SUNNYCREST DR
Practice Address - Street 2:SUITE 3300
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-870-6120
Practice Address - Fax:714-870-6869
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022837001223P0221X
CA570271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry